| Doctor Name: | MRS. MARY VICTORIA JETMORE-REICHARDT |
| NPI Number: | 1548565476 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MP |
| License Number: | 10826 |
| Business Practice Address: | 580 Forest Shade #4 Crestline, CA - 92325 |
| Business Phone Number: | 9093386477 |
| Business Fax Number: | |
| Mailing Address: | Po Box 6493, 22652 Waters Drive CRESTLINE |
| State: | CA |
| Postal Code: | 923256493 |
| Phone Number: | 9162013908 |
| Fax Number: | |
| NPI Enumeration Date: | 01/25/2011 |
| NPI Last Update Date: | 01/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | 10826 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Massage Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |